Print Form Interim/Plenary Order of Protection: 1 of 3 Pages Clear Form CCG N805 A-15M-6/06/07 (This form replaces CCG 83-01) IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS People ex rel. ___________________________________________ Case No. _____________________________________ _____________________________________________ on behalf of Independent Proceeding _______________________________________ self and/or behalf of Other Civil Proceeding (Specify) ______________________________________________________ ________________________________ Criminal Proceeding Petitioner Juvenile Proceeding v. LEADS NO. __________________________________ ______________________________________________________ Respondent _________________________________________________________________________________________________________________________________________ PETITIONER ADDRESS CITY/STATE/ZIP (Check if omitted pursuant to Statute) _________________________________________________________________________________________________________________________________________ RESPONDENT ADDRESS CITY/STATE/ZIP ________________________________________________________________________________________________________________________________________ Birthdate Sex Race Height Weight Hair Eyes (Required for LEADS) ________________________________________________________________________________________________________________________________________ ORDER OF PROTECTION Crim INTERIM 953 Civil 4552 Crim PLENARY 954 Civil 4652 ANY KNOWING VIOLATION OF ANY ORDER OF PROTECTION FORBIDDING PHYSICAL ABUSE, NEGLECT, EXPLOITATION, HARASSMENT, INTIMIDATION, INTERFERENCE WITH PERSONAL LIBERTY, WILLFUL DEPRIVATION, OR ENTERING OR REMAINING PRESENT AT SPECIFIED PLACES WHEN THE PROTECTED PERSON IS PRESENT OR GRANTING EXCLUSIVE POSSESSION OF THE RESIDENCE OR HOUSEHOLD, PROHIBITING ENTERING OR REMAINING AT THE HOUSEHOLD WHILE UNDER THE INFLUENCE OF ALCOHOL OR DRUGS AND SO CONSTITUTING A THREAT TO THE SAFETY AND WELL-BEING OF ANY PROTECTED PERSON, OR GRANTING A STAY AWAY ORDER, IS A CRIMINAL OFFENSE. GRANT OF EXCLUSIVE POSSESSION OF THE RESIDENCE OR HOUSEHOLD SHALL CONSTITUTE NOTICE FORBIDDING TRESPASS TO LAND. ANY KNOWING VIOLATION OF ANY ORDER AWARDING LEGAL CUSTODY OR PHYSICAL CARE OF A CHILD, OR PROHIBITING REMOVAL OR CONCEALMENT OF A CHILD MAY BE A CLASS 4 FELONY. ANY WILLFUL VIOLATION OF ANY ORDER IS CONTEMPT OF COURT. ANY VIOLATION MAY RESULT IN A FINE OR IMPRISONMENT. STALKING IS A FELONY. Any order of protection which would expire on a court holiday shall instead expire at the close of the next court business day. 750 ILCS 60/220 (f) (Definitions of prohibited conduct on reverse) ___________________________________________________________________ ____________________________________________________________________________________________________________ The following persons are protected by this Order: “The minor child/ren” referred to herein are: _____________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Date, time and place for further hearing: Date: ________________________________ Time: _______________ Courtroom/Calendar No.: _______________________ Location: ____________________________________ This Order was issued on: Date: ___________________________ Time: ________________ This Order will be in effect until: Date:_________________________ Time:_______________ Vacated by court order: Specified event: _________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Interim/Plenary Order of Protection: 2 of 3 Pages CCG N805 B-30M-12/01/06 (This form replaces CCG-83-2) BASED ON THE FINDINGS OF THIS COURT, WHICH WERE MADE ORALLY FOR TRANSCRIPTION, OR WHICH ARE SET OUT IN A SEPARATE INSTRUMENT FILED WITH THE COURT, AND WITH THE COURT HAVING JURISDICTION OF THE SUBJECT MATTER AND OVER ALL NECESSARY PARTIES, IT IS HEREBY ORDERED THAT: 1. With respect to all Protected Persons, Respondent is prohibited from committing the following: Physical abuse; Harassment; Interference with personal liberty; Intimidation of a dependent; Willful deprivation; Neglect; Exploitation; Stalking. 2. Petitioner is granted exclusive possession of the residence and Respondent shall not enter or remain in the household or premises located at: __________________________________________________________________________________________________. [This remedy does not affect title to property] 3. 4. 5. 6. 7. a. Respondent is ordered to stay away from Petitioner and other protected persons; and/or b. Respondent is prohibited from entering or remaining at _________________________________________________________ _______________________________________________________________ while any Protected Person is present; and/or ________________________________________________________________________________________. c. Respondent is allowed access to the residence on (date) ____________________ at (time) _______________ in the presence of (name) ________________________________ to remove items of clothing, personal adornments, medications used exclusively by the Respondent and other items, as follows: ________________________________________________________________. Respondent is ordered to undergo counseling at __________________________________________________________________ for a duration of ____________________________________________________________________________________________. a. Petitioner is granted physical care and possession of the minor child/ren; and/or b. Respondent is ordered to: Return the minor child/ren ___________________________________________________________ to the physical care of ________________________________________________________; and/or Not remove the minor child/ren ____________________________________________________________________ from the physical care of Petitioner or ________________________________________________________________________. Petitioner is granted temporary legal custody of the minor child/ren; ____________________________________________________ _________________________________________________________________________________________________. a. Respondent is awarded visitation rights on the following dates and times or under the following conditions or parameters: [No order shall merely refer to the term “reasonable visitation”] ___________________________________________________________________________________________ ________________________________________________________________________________________________ b. Respondent’s visitation is restricted as follows: __________________________________________________________________________________________________ _________________________________________________________________________________________________ c. Respondent’s visitation is denied. (Petitioner may deny Respondent access to the minor child/ren if, when Respondent arrives for visitation, Respondent is under the influence of drugs or alcohol and constitutes a threat to the safety and well-being of Petitioner or Petitioner’s minor child/ren or is behaving in a violent or abusive manner.) 8. Respondent is prohibited from removing the minor child/ren from Illinois or concealing them within Illinois. _____________________ at ____________________________________ _________________________ on _________________________ at _________________ a.m./p.m, with/without the minor child/ren. 9. Respondent is ordered to appear in Courtroom/Calendar 10. Petitioner is granted exclusive possession of the following personal property and the Respondent is ordered to promptly make available to Petitioner said property that is in Respondent’s possession or control, to wit: ________________________________________________________________________________________________________ ______________________________________________________________________________________________ [This remedy does not affect title to property] 11. Respondent is prohibited from taking, encumbering, concealing, damaging or otherwise disposing of the following personal property: ________________________________________________________________________________________________ ______________________________________________________________________, except as explicitly authorized by the Court. Further, Respondent is prohibited from improperly using the financial or other resources of an aged member of the family or household for the point or advantage of Respondent or any other person. 12. Respondent is ordered to pay temporary support for Petitioner and/or the minor child/ren of the parties as follows: through the Clerk of the Circuit Court, $ _________________ per ___________________, starting __________________, payable or directly to Petitioner. 13. Respondent is ordered to pay $ __________________ as actual monetary compensation for loss(es) to ___________________________ on or before _____________________. Further, Respondent is ordered to pay court costs in the amount of $ ____________ and attorney fees in the amount of $ __________ to _________________________________________ in connection with any action to obtain, modify, enforce, appeal or reopen any Order of Protection, on or before __________________________. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Case No. ____________________________ Interim/Plenary Order of Protection: 3 of 3 Pages 14. (This form replaces CCG-83-1) CCG N805 C-35M-5/18/05 Respondent is prohibited from entering or remaining at the household or residence located at ________________________________ __________________________________________________________________________________________ while under the influence of alcohol or drugs and so constituting a threat to the safety and well-being of any Protected Person. 14.5 1. The Court has examined the Petitioner and any other witnesses under oath, has examined the petition and other relevant evidence on the issue of whether Respondent has threatened or is likely to use a firearm(s) illegally against Petitioner, and finds that there is a danger of the illegal use of firearms. The Court finds that the Respondent: has appeared personally in court failed to appear personally after having received actual notice. __________________________________________ ____________________________________________________________________________________________________. Respondent shall turn over the above-listed firearms(s) to the police agency ______________________________________________. on or before ___________________, ______ for safekeeping, to be returned to the Respondent on ___________________, ______ 2. Respondent is ordered to turn over any and all firearms, including the following: 3. (Period not to exceed two years unless otherwise prohibited under federal law. 18 U.S.C. §§ 922(d) and (g)(8), and 922(d) and (g)(9)). 15. Respondent is denied access to school and/or any other records of the minor child/ren and is prohibited from inspecting, obtaining, or attempting to inspect or obtain such records. 16. Respondent is ordered to pay $________________ to the following shelter ______________________________________ on or before 17. Respondent is further ordered and/or enjoined as follows: ____________________________________. ________________________________________________________________________________________________ _____________________________________________________________________________________________________. 18. The relief requested in paragraph(s) __________ of the petition is (DENIED) (RESERVED), because: ________________________________________________________________________________________________ ________________________________________________________________________________________________. “This Order of Protection is enforceable, even without registration, in all 50 states, the District of Columbia, tribal lands, and the U.S. territories pursuant to the Violence Against Women Act (18 U.S.C. 2265). Violating this Order of Protection may subject the Respondent to federal charges and punishment (18 U.S.C. 2261-2262). The Respondent may be subject to federal criminal penalties for possessing, transporting, shipping, or receiving any firearm or ammunition under the Gun Control Act (18 U.S.C. 922 (g) (8) and (9)).” PLENARY ORDERS ONLY This Order shall remain in effect until: 1. two years following the date of entry of such Order, such expiration date being ________________________________________, or such earlier date, as ordered by the Court, such expiration date being __________________________________________________. 2. final judgment in conjoined proceeding is rendered. 3. this Order is modified or vacated (provided such Order is incorporated into the final judgment of another civil proceeding). 4. termination of any voluntary or involuntary commitment, or until ___________________________________________________. (not to exceed 2 years) 5. final disposition when a Bond Forfeiture Warrant has issued, or until _________________________________________________. (not to exceed 2 years) 6. expiration of any supervision, conditional discharge, probation, periodic imprisonment, parole, or supervised mandatory release, plus 2 years. 7. expiration of a term of imprisonment set by this Court, plus 2 years. _ _ _ _ _ _ _ _of_ _ _ _ _which _ _ _ expire_ _a_ _ _ holiday_ _ _instead_ _ _ _ _ _ close_ _ _ next_ _ _ _ _ _ _day._750_ _ _60/220_ _ _ _Any_order _ protection_ _ _ would_ _ _ on _ court_ _ _ _shall _ _ _ expire at the_ _ _of the_ _ _ _ _ _ _ _ _ _ _ _ILCS_ _ _ (f) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ court business _ _ _ _ _ _ _ _ _ NOTICE: Upon 2 days notice to Petitioner, or such shorter notice as the Court may prescribe, a Respondent subject to an Interim Order of Protection issued under the IDVA may appear and petition the Court to re-hear the original or amended petition. Respondent’s petition shall be verified and shall allege lack of notice and a meritorious defense. _________________________________________________________________ ________________________________________________________________ Atty. No. ________________ Attorney (or Pro Se Petitioner) Name: _______________________________ Address: ____________________________________________________ State/City/Zip: Telephone: ________________________________________________ ___________________________________________________ Date: ______________________________, ________ ____________________________________________ Judge Case No. Judge’s No. __________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS DEFINITIONS PURSUANT TO THE ILLINOIS DOMESTIC VIOLENCE ACT 1. "Petitioner" may mean not only any named petitioner for the order of protection and any named victim of abuse on whose behalf the petition is brought, but also any other person protected by this Act. 2. "Abuse" means physical abuse, harassment, intimidation of a dependent, interference with personal liberty or willful deprivation, but does not include reasonable direction of a minor child by a parent or person in loco parentis. 3. "Physical abuse" includes sexual abuse and means any of the following: (a) knowing or reckless use of physical force, confinement or restraint; (b) knowing, repeated and unnecessary sleep deprivation; or (c) knowing or reckless conduct which creates an immediate risk of physical harm. 4. "Harassment" means knowing conduct which is not necessary to accomplish a purpose that is reasonable under the circumstances; would cause a reasonable person emotional distress; and does cause emotional distress to the petitioner. Unless the presumption is rebutted by a preponderance of the evidence, the following types of conduct shall be presumed to cause emotional distress: (a) creating a disturbance at petitioner's place of employment or school; (b) repeatedly telephoning petitioner's place of employment, home, or residence; (c) repeatedly following petitioner about in a public place or places; (d) repeatedly keeping petitioner under surveillance by remaining present outside his or her home, school, place of employment, vehicle or other place occupied by petitioner or by peering in petitioner's windows; (e) improperly concealing a minor child from petitioner, repeatedly threatening to improperly remove a minor child of petitioner's from the jurisdiction or from the physical care of petitioner, repeatedly threatening to conceal a minor child from petitioner, or making a single such threat following an actual or attempted improper removal or concealment, unless respondent was fleeing an incident or pattern of domestic violence; (f) threatening physical force, confinement or restraint on one or more occasions. 5. "Interference with personal liberty" means committing or threatening physical abuse, harassment, intimidation or willful deprivation so as to compel another to engage in conduct from which she or he has a right to abstain or to refrain from conduct in which she or he has a right to engage. 6. "Willful deprivation" means willfully denying a person who, because of age, health or disability, requires medication, medical care, shelter, accessible shelter or services, food, therapeutic device, or other physical assistance, and thereby exposing that person to the risk of physical, mental or emotional harm, except with regard to medical care or treatment when the dependent person has expressed an intent to forgo such medical care or treatment. This paragraph does not create any new affirmative duty to provide support to dependent persons. 7. "Intimidation of dependent" means subjecting a person who is dependent because of age, health or disability to the participation in or the witnessing of physical force against another or physical confinement or restraint of another which constitutes physical abuse as defined in this Act, regardless of whether the abused person is a family or household member. 8. "Exploitation" means the illegal, including tortious, use of a high-risk adult with disabilities or of the assets or resources of a high-risk adult with disabilities. Exploitation includes, but is not limited to, the misappropriation of assets or resources of a high-risk adult with disabilities by undue influence, by breach of a fiduciary relationship, by fraud, deception, or extortion, or the use of such assets or resources in a manner contrary to law. 9. "Neglect" means the failure to exercise that degree of care toward a high-risk adult with disabilities which a reasonable person would exercise under the circumstances and includes but is not limited to: (a) the failure to take reasonable steps to protect a high-risk adult with disabilities from acts of abuse; (b) the repeated, careless imposition of unreasonable confinement; (c) the failure to provide food, shelter, clothing, and personal hygiene to a high-risk adult with disabilities who requires such assistance; (d) the failure to provide medical and rehabilitative care for the physical and mental health needs of a high-risk adult with disabilities; or (e) the failure to protect a high-risk adult with disabilities from health and safety hazards. (See Clerk for definitions available in Spanish or Polish)